The Metacognitive Model of Anxiety in Children: Towards a Reliable and Valid Measure

Abstract

Recent research has extended the metacognitive model of adult psychopathology to childhood anxiety, however the results have been confounded by poor comprehension of the Metacognitions Questionnaire for Children (MCQ-C) amongst 7-8 year olds. The aim of this study was to improve comprehension of the MCQ-C, to enable reliable and valid evaluation of the metacognitive model of anxiety in children. Poorly comprehended items of the MCQ-C were revised to the appropriate reading level and pilot tested with 7-8 year olds. One hundred and eighty seven children aged 7-12 years then completed an online version of the revised MCQ-C (MCQ-CR) and selfreport measures of anxiety symptoms, excessive worry and externalising thoughts. The MCQ-CR was well understood by children as young as 7 years and exhibited sound psychometric properties. As predicted, children's negative beliefs about worry, thoughts in general and memories were found to be significantly positively related to symptoms of anxiety disorders. Confirmatory factor analysis supported the construct validity of the scale. Positive beliefs about worry were not associated with children's worry levels, raising questions about the relevance of this element of the metacognitive model with children. Although further validation is required with a clinical sample, these results provide support for the integral role played by metacognitions in childhood anxiety disorders, and suggest that these mechanisms may be appropriate targets for future early intervention and treatment programs.

The Metacognitions Questionnaire and Its Derivatives in Children and Adolescents: A Systematic Review of Psychometric Properties

“…Bacow et al (2009) report that the MCQ-C has a Flesch-Kincaid Reading Grade Level of two-meaning it should generally be understandable to children ages 7–8. However, Smith and Hudson (2013) tested the understandability of the questionnaire in a sample of fourteen 7–8 year olds and found that a significant proportion of these children did not understand six items on the MCQ-C. Additionally, White and Hudson (2016) reported that six further items were assessed as being above Grade 2 level according to Fry's (1977) criteria.…”

“…These questionnaires were adapted from the MCQ-A by simplifying words and phrases further to make them understandable to a younger age group. Recently the Metacognitions Questionnaire-Child Revised (MCQ-CR; White and Hudson, 2016) has been developed with the aim of making the questionnaire understandable to younger children (from age 7 to 8). Studies using young populations have also used the positive belief scale of the MCQ-65 adapted to be understandable to children (Meiser-Stedman et al, 2007) as well as adult versions of both the MCQ-30 and a measure derived from the cognitive self-consciousness subscale of the MCQ-30, the Cognitive Self Consciousness scale-Expanded (CSC-E; Janeck et al, 2003).…”

Validation of the French version of the « Meta-Cognition Questionnaire » for adolescents (MCQ-Af): Evolution of metacognitive beliefs with age and their links with anxiety during adolescence

“…Studies having measured metacognitive beliefs, as well as control and monitoring of thoughts using the MCQ, yield heterogeneous results concerning their evolution with age, in clinical or non-clinical samples [6,[25][26][27][28]. Some authors have suggested that metacognitive beliefs at the age of 13 could be compared to metacognitive beliefs in adulthood [25,27,29].…”

“…[6] did not account for any significant effect, as well as Esbjorn and al., in a sample of children and adolescents between 9 and 17 tested on the metacognition questionnaire for children (MCQ-C30) [18]. Several studies, even if showing an increase of factors' scores up until the age of 13, noted no significant results in increase after that age in all metacognitive scores of the MCQ-A [6,25,26,28]. Some authors have suggested that metacognitive beliefs at that age could be compared to metacognitive beliefs in adults [25,27,29].…”

Practitioner Review: Anxiety disorders in children and young people – assessment and treatment

“…Further, combining questionnaire data from parents and the young person leads to a richer and sometimes more accurate perspective of the child's symptoms (Reardon, Creswell, et al, ). Most youth‐reported questionnaires are designed for children 7 years and up; however, children's reading and cognitive ability at this age vary dramatically and research has highlighted that a portion of children do not understand the questionnaires presented to them (White & Hudson, ). It is therefore important to consider whether the measure is appropriate for the child's developmental stage when deciding which reporters to include and which questionnaire measures to choose.…”